| NPI | 1952369720 |
|---|---|
| Former Name | CAROLYN A. BRUSTAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 24282) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901018922) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2024-06-25 |